Compassion in Action: The Cambodia AIDS Project

One of my readers recently reminded me of Brahmavihara/The Cambodia AIDS Project, a small Buddhist chaplaincy program working with Cambodian AIDS patients too poor to access traditional resources. The program was founded in 2000 by Beth Goldring.

Since the tagline for The Jizo Chronicles is “Bodhisattvas in the Trenches,” I’m always on the lookout for powerful first-hand accounts of engaged dharma. Beth more than fits that description. She is an American Zen nun who has studied with Gil Fronsdal, as well as a former ballet dancer, university humanities teacher, and human rights worker. Beth works closely with Cambodian staff members to fulfill the project’s mission.

I found this article by Beth on the Brahmavihara website, which was originally published in the German Buddhist Association magazine in Spring 2004. It’s a wonderful exploration of the role that intention plays in service work. Here’s an excerpt:

When I began this project my intention was to help people die peacefully, confident in the Buddha’s boundless compassion. That is still true. Every bit of our work is directed towards helping people realize that the Buddha’s compassion is already fully present–right in the middle of their suffering.

What has changed enormously in the past five years is my sense of what this intention entails. What is striking me most powerfully recently is the need for us to let go of every other intention beyond seeing clearly and accepting completely the person: just as they are right in the middle of their suffering.

And here is the full article–I hope you enjoy it.

___________________

Working Without IntentionAIDS, Death and Dying among the Cambodian Destituteby Beth Goldring
Brahmavihara/Cambodia AIDS Project
Phnom Penh

Sok is lying on the floor in the tuberculosis hospital dying of AIDS. She is partly outside her mosquito net. Her face has taken on the alienated, impersonal quality people sometimes get when death is approaching. Her skin has open sores but she is beyond paying attention to them. Lok Yay, the Cambodian nun who works with me, simply pulls on her gloves and begins massaging Sok, making soothing sounds. Ramo, my assistant, and I go into the next room to do Reiki with another patient. By the time we come back Sok has returned to herself. She is sitting up, held by Lok Yay, who is also feeding her a little rice porridge. Sok is very weak but she is once again a specific, recognizable human person.

The next day Ramo and I take Sok’s little daughter, who also has AIDS and lives in a group home for children, for a final visit with her mother. Sok is lying in her bed and Lok Yay has shaved her head. Srey Tout, who is only three, is terrified. I sit next to Sok on the bed. Srey Tout, on my lap, sits so that she doesn’t have to see this person she is too terrified to know. We visit quietly. Slowly Srey Tout begins to give tiny glances to this person in the bed. Slowly she recognizes this person as her mother who loves her. Eventually she allows Sok to give her some hard candies and to kiss her. Sok is radiant, even in the face of her impending death. She dies within days.

Recently I received a set of wonderful letters about the death of a Thai woman practitioner, written by a fellow practitioner and friend who accompanied her dying. A Thai monk who translates Sogyal Rinpoche and the Dalai Lama into Thai also assisted. What was breathtaking was the ongoing intimacy between her spiritual practice and her dying. Her ability to incorporate her dying, with its pain and difficulties, into her practice seemed seamless. I was and remain in awe of it.

Our work, while it does not lack inspiration, is not like this. In writing this paper I am increasingly forced to realize how little of our actual experience with death and dying in Cambodia conforms to the patterns normal for discussions of death and dying and Buddhist teachings. This worries me because I would like to make a bridge between the conditions we work under and the conditions normally taken for granted in the West.

Ordinary Cambodians have seen more death and dying than most Westerners can easily imagine. Most of it has taken place under terrible conditions: war, torture, brutality, starvation, lack of the most elementary medical care. I know of no adult over 30 who has not watched at least one family member starve to death or die from lack of elementary medical treatment during the Khmer Rouge period( 1975-79). Recently there are also mob killings of people suspected of stealing motorcycles (one of which took place in a wat with monks looking on) and arbitrary killings because of drunkenness or in the course of theft. There are also routine suicides and regular killing of rape victims, many of them tiny children. A look at the biweekly Police Blotter in the Phnom Penh Post gives the picture of a society in which death is routine and trivial. Deaths from tuberculosis, malaria and AIDS, an increasing infant mortality rate, a terrible maternal mortality rate and routine child deaths from malnutrition, diarrheal diseases and fevers broaden but hardly complete the picture.

Buddhist teaching in Cambodia has not recovered from the legacy of war and genocide. The clergy were destroyed under the Khmer Rouge and politically controlled during the Vietnamese period (1979-91). With some stunning exceptions, the reconstruction of Buddhist teachings has lacked skilled and knowledgeable teachers. This handful of skilled teachers are called upon to do everything from reconstructing the teaching of Pali through operating rice banks to conducting anti-smoking campaigns. While the level of knowledge is to some degree being reconstructed and there are monks and achars and nuns to chant and perform ceremonies the deeper knowledge of what the tradition means takes a far longer time to develop. One such stunning exception to these problems is the annual dhammayietra (peace walk) in which the commitment of monks, nuns, achars and laypeople to dhamma and to peace in Cambodia is palpable in every step they take.

It is impossible, however, that the increasing and uncontrolled corruption that stains every level of Cambodian society has left Buddhism untouched. Too often the wats lack even the most elementary discipline; too often the monks, mostly young boys, are taught simply that people should give them things; too often they are encouraged to study English and computer and not dharma. The nuns are old women. Since they receive little if any support from the wats (normally they have to build their own cottages to live in and may or may not receive food) they largely come from families able to support them. Many wats have no nuns at all and no space or welcome for them. The nuns tend to congregate in wats where there is dharma training for them. There they are respected for the sincerity of their practice but they are not sought out for their wisdom. The Association of Nuns and Laywomen in Cambodia works to provide encouragement, support and training but it is the only active institution working on their behalf. The achars (older men who keep five precepts and run ceremonies as well as the temporal affairs of the wats) are a mixed group. Some of them have studied dharma for a long time; others tend to concentrate almost exclusively on the material side of the work.

I am not saying things this critical of the current situation in Cambodian Buddhism lightly. The situation is all too understandable given Cambodia’s history of massive and ongoing trauma. Often I am astounded by the Cambodian capacity for recovery in the face of it; for the kindness and compassion we find in desperate situations. I doubt I would have even one-thousandth of the grace under stress we are routinely privileged to witness. But without at least some background in the realities of current Cambodian Buddhism the problems the dying face are unintelligible. I know of one monk who sits with dying people. He works in a project which is mixed Christian and Buddhist and which has a home care project, a hospice and programs for orphans. I have heard of other monks who visit the sick. I have heard of, but not seen, one wat where the destitute dying are accepted and where orphans are taken care of.

Our patients don’t ask the monks to come and chant because they have nothing to give them and are ashamed. Our patients believe that their destitution and AIDS are the result of their karma. They believe that their poverty, suffering and disease place them outside the Buddha’s concern and care. They know of no other way to overcome this problem except by giving things to monks. They believe that because they have nothing to give the monks their next lives will be even worse. It is easy for them to hate and fear death; they have seen too much of its ugliest face. It is especially easy for them to die in terror, rage or simple alienated, exhausted indifference.

When I began this project my intention was to help people die peacefully, confident in the Buddha’s boundless compassion. That is still true. Every bit of our work is directed towards helping people realize that the Buddha’s compassion is already fully present–right in the middle of their suffering.

What has changed enormously in the past five years is my sense of what this intention entails. What is striking me most powerfully recently is the need for us to let go of every other intention beyond seeing clearly and accepting completely the person: just as they are right in the middle of their suffering. It means using all the tools we can bring to bear on the situation: chanting, meditation, ceremonies (including ghost ceremonies), Reiki, massage, amritta, candles, incense, small Buddha statues, pictures, whatever practical assistance we can offer and whatever compassion our own training and practice allow us to embody. But, paradoxically, it means using those tools without any idea of accomplishing anything with them.

It is late Friday evening. Bunna is dying in her house. She is a woman of intelligence and fortitude and has refused to go to the hospice or hospital. This afternoon she was restless and upset. She also had uncontrolled diarrhea, which shamed her since she had no strength to change her clothing or clean it. Chey Lang, who has just received her Reiki II initiation, came with Veasna, my second translator. They cleaned everything, cooked some rice porridge and fed her as much as she could eat. Chey Lang did Reiki and they left her resting in her mosquito net with the things she needed easily at hand. Meanwhile I had called her home care supervisor, who said they would pay for someone to care for her if we could find the person.

Ramo and I have come back and have asked Ka, who is normally practical, warm and energetic, to be the caregiver. Ka agreed. But when she arrived she was badly out of control emotionally because of her own problems. Her organization (different from Bunna’s) had just cut housing subsidies and the people caring for Ka’s children had sent them back. She had nothing to feed them. Although Ka wants the job for financial reasons she is in no emotional state to do it. She becomes hysterical about the house not being safe; about whether her own antiretroviral medication might be stolen; about where she will sleep since her mosquito net is too big for the available space; about anything and everything. She does not interact with Bunna, who, meanwhile, is withdrawing further and further into herself. I tell Ka that we have other people for the job but she insists she wants it, calms down a bit and goes to get her things. While we are waiting another woman comes in, ostensibly to see about Bunna but actually to scream about her own problems and situation. Bunna by this time is practically in a fetal position; her eyes are withdrawn, shadowed and hollow and her mouth is a rictus. I feel that she is willing to die immediately, just to get away from the hysteria surrounding her. I leave Ramo to deal with the other woman and get back into the mosquito net with Bunna. I start to do Reiki, very gently and simply. Slowly she turns over onto her back. I move the pillows behind her, raising her head to help with her lung congestion. She is too weak to cough up matter from a lying down position.

The visitor leaves and Ka comes back to tell us her son has disappeared and that she can’t stay with Bunna because she has to go find him. Ramo deals with her gently but we are both enormously relieved. We call Lok Yay’s assistant and ask him to bring another woman we know, Heng, who is gentle and kind. I do not expect Bunna to live even the half hour that it will take them to arrive.

I have been studying about giving Reiki attunements to the dying and it strikes me that there could hardly be a better time to start. So I do what I can, holding in my mind no intention or simply the intention that Bunna go as peacefully as is possible. Focussing on the attunement process I am not watching her face closely. When I look back at her she is peaceful and present and I feel an enormous gratitude.

Heng arrives and immediately gets under the mosquito net with her cheerful, peaceful presence. We make the necessary arrangements quickly and without fuss. Bunna is concerned that I am there very late in the evening and must be tired. It is characteristic of her to be concerned about me as soon as she is reasonably conscious again.

That was February 27. Bunna went into the hospital March 3, was eating successfully, even corn on the cob, several days later and began antiretrovirals March 10. Perhaps she will make it.

My sense of things right now is that it is necessary to let go of all intentions, even, at one level, the intention of helping someone find peacefulness. My sense is that the more we are able to do this, the more we are able to let people be who they are, to have their own lives and deaths and not the ones we might wish for them, the more effective the work will be at the deeper levels. This does not mean withholding our skills, capacities, knowledge and/or most powerful efforts. Rather it means using them as fully as we possibly can, moment to moment. But it also means using them unconditionally, letting go of all ideas about what should happen or how it should happen.

There is, of course, nothing new in this. It is classic Buddhist teaching and teaching that Zen, in particular, emphasizes strongly. Cambodia is an easy place to learn about the limitations of efforts. But it is also a wonderful place to learn about the power of what works through us when we let go of ideas. We are enormously privileged to be able to work here.

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About Maia

I've been practicing and studying the Buddha way since 1994, and exploring the question "What is engaged Buddhism?" since the late 90s.
As former executive director of the Buddhist Peace Fellowship and editor of its journal, Turning Wheel, I had the honor of meeting and working with many practitioners of engaged dharma, including Roshi Joan Halifax, Joanna Macy, Alan Senauke, and Robert Aitken Roshi.
I write about socially engaged Buddhism on my blog, "The Jizo Chronicles," as well as on the theme of personal and collective freedom on my website, "The Liberated Life Project." Through my Five Directions Consulting, I offer support to individuals and organizations who aspire to integrate awareness into their work.